2012 Report

Strategies for Serving Our

Women Veterans
Department of Veterans Affairs
Women Veterans Task Force

Draft for Public Comment • May 1, 2012

“We, at VA, must be visionary and agile enough to anticipate and adjust not only to the
coming increase in women Veterans, but also to the accompanying complexity and
longevity of treatment needs they will bring with them.”

Secretary Shinseki, July 16, 2011

Preface

This draft strategy report was developed by the Women Veterans Task Force
(WVTF) of the Department of Veterans Affairs (VA). The task force, which was
called for by Secretary Shinseki in July 2011, is chaired by the VA Chief of Staff with
the three Under Secretaries serving as a governing board.

In preparation for the task force’s effort, background on the “as is” state of services
and benefits for women Veterans was documented in the fall of 2011 by a working
group with representatives from all VA administrations. The WVTF, which
commenced work in February 2012, consists of subject matter experts from across
VA, representing the Veterans Health Administration (VHA), Veterans Benefits
Administration (VBA), National Cemetery Administration (NCA), and VA
headquarters (VACO). Full membership of the WVTF is shown in Appendix A.

This draft report is an interim deliverable, representing the work of the WVTF
emerging from a four-day offsite in March. Public comments on this draft are
welcome through June 14, 2012 and should be submitted through the Federal
Register Web site www.regulations.gov.

Following the comment phase, a revised strategy report will be developed

presenting the task force’s recommendations for continuously improving services
for women Veterans across the entire Department. In addition to the strategy
report, the task force will develop an action plan for implementing the
recommended strategies, specifying costs, work plans, performance measures,
organizational accountabilities, and associated risks. The action plan will update and
inform VA’s approach to women’s issues within the health care, benefits, and
cemetery administrations, and will guide the agency in planning and
implementation of programming, budgeting, education and training. The task force
is posting the draft strategy plan/report for public comment at an early stage in
order to elicit the creative thinking and expert opinions of a wide range of
stakeholders.
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 1

Draft for Public Comment, May 1, 2012

2012 Report
Strategies for Serving Our Women Veterans

Table of Contents
INTRODUCTION ..........................................................................................................2

CAPACITY AND COORDINATION OF SERVICES ............................................................ 14

ENVIRONMENT OF CARE AND EXPERIENCE................................................................ 16

EMPLOYMENT AND TRAINING .................................................................................. 18

DATA COLLECTION AND EVALUATION OF SERVICES ................................................... 20

ORGANIZATIONAL ACCOUNTABILITY, COLLABORATION, AND TRANSPARENCY .......... 21

CONCLUSION ............................................................................................................ 22

APPENDIX A .............................................................................................................. 23

APPENDIX B .............................................................................................................. 24
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 2

Introduction
The Department of Veterans Affairs (VA) is committed to transformation, with the
aim of becoming an increasingly Veteran-centric, results-oriented, and forward-
looking organization. In line with this commitment, Secretary Shinseki called for the
formation of a Women Veterans Task Force (WVTF) in July 2011, to be charged with
developing a comprehensive VA action plan for resolving gaps in how our
organization serves women Veterans. As an interim deliverable, the WVTF
developed this draft strategy report to solicit stakeholder feedback on its initial
findings and recommendations. Based on public comments to this draft, the WVTF
will finalize its recommendations and develop a detailed action plan for
implementation.

The urgency of this effort is acute, given the rapid growth of the women Veteran
population. Consider these facts, which Secretary Shinseki cited in announcing the
formation of the WVTF:

Fully 14 percent of active duty and 18 percent of National Guard and

Reserves forces are now women. In contrast, the percentage of women in
uniform was just 2 percent in 1950.
The nature of warfare places women in hostile battle space in ever-
increasing numbers, with ever-increasing opportunity for direct-fire combat
with armed enemies.
Women are sustaining injuries similar to their male counterparts, both in
severity and complexity.

Women are now the fastest growing cohort within the Veteran community. In 2011,
about 1.8 million or 8 percent of the 22.2 million Veterans were women.1 The male
Veteran population is projected to decrease from 20.2 million men in 2010 to 16.7
million by 2020. In contrast, the number of women Veterans will increase from 1.8
million in 2011 to 2 million in 2020, at which time women will make up 10.7
percent of the total Veteran population.

The population of women Veterans has grown steadily over the last decade because
of the increasing number and proportion of women entering and leaving the
military, the more favorable survival rate of women compared to men at any given
age, and the younger age distribution of women Veterans compared to male
Veterans. In 2010, the estimated median age of female Veterans was 48, compared
to 62 for male Veterans.

1 Department of Veterans Affairs, VetPop07, at http://www.va.gov/vetdata/

Note: The 2010 American Community Survey reported that 1.6 million or 7 percent of the 21.8 million Veterans were
women. VetPop07 figures are projections based on Census data through 2006.
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 3

Building on Our Accomplishments

Providing high-quality care and benefits for America’s Veterans is at the heart of VA
core values. “Because I CARE, I will” articulates who we are at VA: professionals who
seek to embody the values of Integrity, Commitment, Advocacy, Respect, and
Excellence in our service to Veterans. It calls us to action across VA, recognizing that
living these values requires continuous improvement, based on a resolve to identify
weaknesses and rigorously correct them.

When it comes to the treatment of women Veterans, we at VA have been working

diligently to deliver on our I CARE values. Our efforts at continuous improvement
are informed by a series of reports issued over the past 25 years by the Secretary’s
Advisory Committee on Women Veterans, the Government Accountability Office
(GAO), Congress, and internal VA groups that have identified gaps in access to and
delivery of services and benefits for women Veterans. The history of
recommendations and VA responses is summarized in Appendix B. Despite
considerable progress over the years, gaps do remain and VA continues to strive to
identify and resolve them.

Fortunately, we have a strong foundation to build on. Efforts under way across VA
pertaining to delivery of services and benefits to women Veterans include:

Collaborative outreach efforts led by the Center for Women Veterans (CWV)
to build awareness among women Veterans of the benefits and services
provided by VA, and to champion cultural transformation within VA.
Initiatives led by the Women Veterans Health Strategic Health Care Group
(WVHSHG) within VHA that have resulted in implementation of
comprehensive primary care for women Veterans, training of VA providers in
basic and advanced women’s health care, launching of the Women’s Health
Evaluation Initiative, revision of the VHA Handbook 1330.01: Health Care
Services for Women Veterans, installation of full-time Women Veterans
Program Managers (WVPMs) at VA facilities nationwide, enhancement of
mental health and homeless services for women Veterans through
collaboration across program offices, and ramped-up communications to and
about women Veterans.
The development by the Office of Mental Health Services of an Military Sexual
Trauma (MST) Support Team and MST program; and the implementation of
national MST training for primary care and mental health providers.
The designation by VBA of Women Veterans Coordinators (WVCs) to
outreach to women Veterans, to promote the use of VA benefits by women
Veterans and to assist women Veterans in developing claims, especially those
claims involving issues of a sensitive nature such as MST. As of August, 2010,
VBA reported having a total of 73 WVCs nationwide. All regional offices
(ROs) have at least one individual designated to serve as the WVC and larger
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 4

offices have two or three employees assigned to the task. WVCs are also
located in national call centers and out-based locations.

Another resource is the Secretary’s Advisory Committee on Women Veterans

(ACWV), established in 1983, which has reporting requirements to the Secretary
and to Congress. The Committee’s role is to provide advice to the Secretary on the
needs of women Veterans with respect to health care, rehabilitation, benefits,
compensation, outreach, and other relevant programs administered by VA. The
ACWV develops recommendations to address unmet needs that have implications
for the entire women Veterans population, based on information presented during
briefings at Committee meetings and site visits.

Thanks to all of these initiatives, measurable gains were achieved in recent years.
For example:

More women are now aware of and benefiting from VA services than ever
before. The first VA-commissioned survey of women Veterans in 1985
revealed that 57 percent of women Veterans did not know they were eligible
for VA services or benefits. By 2009, about 30 percent of women Veterans
surveyed did not think they were eligible for VA benefits. While this number
is still unacceptably high, it does represent a marked improvement in
awareness levels.
VA outperforms the private sector in breast and cervical cancer screenings. In
2008, 87 percent of women Veteran patients received breast cancer
screenings and 92 percent received cervical cancer screenings compared to
commercial health care, which scored 69 percent and 82 percent,
respectively.2

Current Status of Women Veterans

VA has made significant progress in serving women Veterans, but work remains to
be done. Not all of our systems are equipped to address the comprehensive needs of
women Veterans or to provide certain services and benefits for which women
Veterans have a greater need relative to their male counterparts. Many women
Veterans still do not know about or think they are eligible for services. Some
gender-based health disparities continue to exist. Data collection gaps hamper our
understanding of women Veterans' needs and their utilization of VA benefits and
services. We can do better in providing an inviting and secure environment of care,
matching capacity to women’s health care needs and demands, and ensuring that
high-quality services are rendered in a respectful and sensitive manner. It is the
desire to achieve systemic improvements in addressing such issues that prompted
formation of the WVTF by Secretary Shinseki.

2
State of Health Care Quality Report, 2008, www.ncqa.org
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 5

In health care, in particular, the VA has the opportunity to become a national model
for service delivery that successfully addresses gender-specific needs. Recent
research indicates that health programs that are gender-responsive — taking
gender issues into account in health policy, planning, practice, and research — are
not only more effective in reducing health inequities, but also exhibit greater
efficiency.3

Available data reveal several characteristics of women Veterans that should be

considered in ensuring gender-responsive services and benefits:

Higher physical and mental health needs.4 A higher proportion of female Veterans
(22 percent) are diagnosed with mental health problems than male veterans.5 The
most common diagnoses among women Veterans seeking care are PTSD,
hypertension, depression, high cholesterol, low back pain, gynecologic problems,
and diabetes. Studies show that 31 percent of women Veterans have both medical
and mental health conditions compared with 24 percent of male Veterans. Among
women Veterans with diabetes, 45 percent have a serious mental illness or
substance use disorder. In FY 2009 and FY 2010, PTSD, hypertension, and
depression were the top three diagnostic categories for women Veterans treated by
VHA.6

Higher incidence of Military Sexual Trauma (MST). One in five women Veterans who
use VA for health care screen positive for MST. 7Women who enter the military at
younger ages and those of enlisted rank appear to be at increased risk for MST. In
addition, women who have had sexual assaults prior to military service report
higher incidences of MST.8 MST has been associated with increased risk of
depression, PTSD and substance use. Females experiencing MST are more than four
times more likely to have PTSD and are at six-fold increased risk for having three or
more mental health conditions. In FY 2011, the most recent year for which data are
available, 19.4 percent of OEF/OIF/OND female Veterans reported a history of MST

3
Guidelines for the analysis of gender and health. Liverpool School of Tropical Medicine, Gender and Health Group
4
Report of the Under Secretary for Health Workgroup: Provision of Primary Care to Women Veterans. Women
Veterans Health Strategic Health Care Group. November 2008
5
VA Office of Inspector General, “General Combat Stress in Women Receiving VA Healthcare and Disability
Benefits.”
6
Women Veterans Health Workload Report. October 2010
7
The definition of MST used by the VA is given by U.S. Code (1720D of Title 38): “psychological trauma, which in the
judgment of a VA mental health professional, resulted from a physical assault of a sexual nature, battery of a
sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty or active duty
for training.” MST includes any sexual activity where someone is involved against his or her will—he or she may
have been pressured into sexual activities (for example, with threats of negative consequences for refusing to be
sexually cooperative or implied faster promotions or better treatment in exchange for sex), may have been unable
to consent to sexual activities (for example, when intoxicated), or may have been physically forced into sexual
activities. MST includes unwanted sexual touching or grabbing; threatening, offensive remarks about a person’s
body or sexual activities; and threatening and unwelcome sexual advances.
8
A. Suris and L. Lind, “Military Sexual Trauma: A Review of Prevalence and Associated Health Consequences in
Veterans,” Trauma Violence Abuse Vol. 9, No. 4 (October 2008) pp. 250-269.
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 6

when screened by a VA healthcare provider compared with 0.9 percent of

OEF/OIF/OND male Veterans. Rates of MST reported among all Veterans screened
at the VA were 23.0 percent for females and 1.2 percent for males for FY 2011.9

Lower access and enrollment of VA health care. The number of women Veterans
using VA has increased 83 percent in the past decade, from about 160,000 to over
292,000 between FY 2000 and FY 2009, compared with a 50 percent increase in
men.10 Lifetime female health care expenses are a third higher than male expenses.11
Although the number of women Veterans using VHA has increased over time, it is
important to note that women Veterans are still approximately 30 percent less
likely to enroll in VHA than men.

Gender-based disparities in healthcare quality. Health care quality scores related to

contributors to cardiovascular disease risk (management of high blood pressure,
high cholesterol, and diabetes) were worse for women Veterans when compared to
male Veterans.12 There are also disparities between men and women in preventive
care statistics. Fewer women Veterans received colorectal cancer screening,
depression screening, and immunizations (pneumococcal and influenza) compared
to male Veterans. Pharmacy data indicate that women in VA are more likely to be
prescribed inappropriate drugs than men.13 Although gender-based disparities in
health care exist in the private sector as well, VA is in an excellent position to
understand why the gaps occur and to implement systems of care that can close
them.

Higher rates of homelessness. Secretary Shinseki made a commitment to ending

homelessness among our nation’s Veterans by 2015. In December 2011, VA and the
Department of Housing and Urban Development announced that homelessness
among Veterans decreased by 12 percent between January 2010 and January
2011.14 While the overall number of homeless Veterans is declining, the number of
homeless women Veterans is increasing. Women Veterans are the fastest growing
segment of the homeless population and are at higher risk of homelessness than
their male counterparts.15 Female Veterans also are more than twice as likely to be

9
Military Sexual Trauma Support Team (2012). Military Sexual Trauma (MST) Screening Report, Fiscal Year 2011.
Washington DC: Department of Veteran Affairs, Patient Care Services, Office of Mental Health Services.
10
Frayne SM, et al. Sourcebook: Women Veterans in the Veterans Health Administration. Volume 1.
Sociodemographic Characteristics and Use of VHA Care. Women’s Health Evaluation Initiative, Women Veterans
Health Strategic Health Care Group, VHA. December 2010.
11
Alemayehu B & Warner K. The lifetime distribution of healthcare costs. Health Service Research, June 2004.
12
Wright SM, Lucatorto MA, Yano EM. An analysis of the quality of care provided to men and women in the VA
health care system.
13
Systematic Review of Women Veterans Health research 2004-2008, October 2010. VA Health Services Research
and Development Service.
14
These homeless statistics are drawn from a survey taken each January, known as a “Point-in-Time” counts. The
January 2011 survey found 67,495 homeless veterans, down from 76,329 one year earlier.
15
“Homelessness Among Women Veterans,” presented at 2011 National Training Summit on Women Veterans by
Stacey Vasquez.
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 7

homeless when compared to female non-Veterans in the United States and female
Veterans living in poverty are more than three times more likely to be homeless
than female non-Veterans in poverty.16 Younger Veterans (18–29 years) were at
higher risk for homelessness, with young, female black Veterans at the greatest risk.

Need for access to child care. The Secretary’s Advisory Committee on Women
Veterans recommended in its 2010 report that VA provide childcare options for
eligible Veterans, utilizing public and private partnerships, in order to facilitate their
access to quality health care services. Under the Caregivers and Veterans Omnibus
Health Services Act of 2010 (PL 111-163), Congress required VA to implement a
two-year childcare pilot in no fewer than three separate Veteran Integrated Service
Networks (VISN). The law requires that the pilot program assess the feasibility and
advisability of providing assistance for childcare to qualified veterans receiving VA
care. Since many Veterans, particularly women Veterans, are the primary caretakers
for young children, it is hoped these childcare centers will make it easier for such
Veterans to utilize VA. In a survey, VA found that nearly a third of Veterans were
interested in childcare services and more than 10 percent had to cancel or
reschedule VA appointments due to lack of childcare. The intent is to diminish
barriers for Veterans who have difficulty keeping appointments due to child care
obligations. The law limits the provision of childcare assistance to these pilot
programs, and eligibility is defined as being for qualified Veterans receiving VA
health care services on an outpatient basis at a VA facility.

Higher level of service-connected disability ratings. In FY 2009, among users of VA

health care, a higher proportion of women Veterans had service-connected (SC)
disability ratings than men (55 percent versus 41 percent). Of these, 26 percent of
women and 19 percent of men had a disability rating higher than 50 percent. The
fact that more than half of women Veterans now carry an SC disability rating and
that many are young holds implications for the future as they will be eligible for
compensation and VHA care for many years.17

Higher demand for education benefits among OEF/OIF/OND women Veterans.

According to the 2010 National Survey of Veterans, overall 35.2 percent of women
Veterans used VA education benefits, which was comparable to the 36 percent of
male Veterans who used such benefits. However, 50.6 percent of females serving in
OEF/OIF/OND were likely to report using benefits compared to 37.2 percent of
males in OEF/OIF/OND.

Underrepresentation in memorial services. The Advisory Committee on Women

Veterans (ACWV) cited concerns that women Veterans may be underrepresented

16
Culhane DP. Prevalence and Risk of Homelessness among US Veterans: A Multisite Investigation. August 2011.
Available at: http://works.bepress.com/dennis_culhane/107
17
Frayne SM, et al. Sourcebook: Women Veterans in the Veterans Health Administration. Volume 1.
Sociodemographic Characteristics and Use of VHA Care. December 2010. Pp. 11-12
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 8

among those interred in National and State Veterans’ cemeteries. From 2001 to
2010, 10.0 percent of male Veterans received burial in a national cemetery,
compared to 8.8 percent of women Veterans. For Veterans not interred in National
cemeteries, there is a significant disparity between the percentage of women who
receive headstones or markers (14.2 percent) compared to men (46.8 percent).
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 9

Defining Priority Themes

In recognition of the growing numbers and needs of women Veterans, Secretary
Shinseki called for a Women Veterans Task Force in July at the 2011 National
Training Summit on Women Veterans. The goal of the Task Force is to develop a
comprehensive VA action plan that will focus on key issues facing women Veterans
and the specific actions needed to resolve them. The action plan will update and
inform VA’s approach to women’s issues within the health care, benefits and
cemetery administrations, and will guide the agency in everything from planning to
implementation of programming, budgeting, education and training. The task force
is to develop the action plan for implementation in coordination with VA’s Advisory
Committee on Women Veterans (ACWV).

To provide the Women Veterans Task Force a foundation for their work, a VA
workgroup was formed to develop a better understanding of VA’s current efforts to
serve women Veterans and collect gender-specific data on women Veterans. While
initiatives directed towards women Veterans exist in every VA administration and
service line, they may not be coordinated. A broad survey of VA’s gaps in services
and current efforts to meet these needs was conducted to inform the way forward
for the task force.

The workgroup involved subject matter experts (SMEs) from all the major service
lines to ensure that all major VA programs targeted to women Veterans were
included. Administration leads were asked to appoint an appropriate SME designee
to participate on the workgroup. Next, SMEs who were members of the workgroup
were asked to submit answers to a list of priority issues facing women Veterans.

The identified issues or needs of women Veterans, as reported by SMEs, included

the following:

Underutilization of services
Lack of awareness of benefits or eligibility
Personal privacy and environment of care
Fragmentation and gaps in health care
Access to mental health care services
Access to gender-specific specialty care (OB/GYN)
Gender-based health disparities
Underrepresentation in research; lack of data
Unemployment
Homelessness
Need for child care
Military sexual trauma (MST) and related issues (i.e. PTSD coverage,
employment, etc)
Domestic violence
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 10

The initial list of priority issues was presented for a roundtable discussion on
November 4, 2011.

Participants then discussed how VA has worked to address issues for women
Veterans over the years. Concerns over these efforts could be grouped into several
themes as well:

Outreach to women Veterans

Coordination across the department, duplication of services, and need for a
department-wide strategy to address women Veterans
Roles and responsibilities of Women Veterans Program Managers (VHA),
Women Veterans Coordinators (VBA), the Center for Women Veterans
(CWV), and the Advisory Committee on Women Veterans
Need for department-wide planning and programming to meet increased
demand from the future population of women Veterans.

At the conclusion of the November 4 roundtable, participants prioritized the issues

as:

Capacity and coordination of services

Women Veterans’ experience of care and environment of care
Employment and training
Data collection and evaluation of services

Evaluation of these themes by the working group informed the efforts of the WVTF
during its four-day workshop in March 2012.
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 11

Addressing Two Overriding Questions

Despite the very real progress in recent years and the concerted efforts under way
throughout VA, gaps persist in our services and benefits to women Veterans. Given
the projected continued growth in the women Veteran population, it is imperative
that we make systemic changes within VA to better understand and address their
unique service and treatment needs.

Two overriding questions have shaped the work of the WVTF:

What is the nature of gaps that persist; and

What do we need to do differently across VA to eliminate them?

In evaluating these questions, the WVTF surveyed the 25-year history of VA efforts
to better serve women Veterans and began to gather available data on “as is”
conditions across our service lines. To date, the initiatives undertaken pertaining to
women Veterans have been conducted almost exclusively within the individual VA
administrations or offices. Data pertinent to women Veterans are not always shared
and correlated across VA organizational boundaries. As a result, some questions
about women Veteran’s unique needs and their level of awareness of, access to, and
satisfaction with VA services and benefits remain unanswered.

Initial Conclusions
The WVTF concluded that transforming VA to meet the needs of the growing cohort
of women Veterans will require:

Leadership support and championing of a comprehensive, collaborative cross-

VA strategy for continuously improving service and benefits delivery to
women Veterans, based on evidence, ongoing data collection and evaluation,
performance measures, and significant input from stakeholders. The WVTF
recommends that four priority themes (defined below) be the focus of the
first action plan, and that care be taken to leverage, rather than duplicate,
work related to these themes that is being actively undertaken in other VA
forums, including the Women Veterans Health Strategic Health Care Group
(WVHSHG), the VA/Department of Defense (DoD) Employment Task Force,
the DoD/VA Integrated Mental Health Strategy, the VHA National Leadership
Council's Veteran Experience Committee, and the VA Homelessness Program.
Enhancing organizational accountability, collaboration, and transparency.
Despite leadership support, significant efforts made to date, and passionate
internal and external stakeholders, VA activities to improve services and
outreach to women Veterans are fragmented. Recommendations to enhance
the effective delivery, accountability, resource management, and
sustainability of services and benefits for women Veterans will include
developing a department-wide integrated plan for meeting the needs of
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 12

women Veterans; analyzing current organizational design, relationships and

internal accountability measures and mechanisms; identifying organizational
and business process enablers and barriers throughout VA; identifying
opportunities for improvement; and formalizing the roles, responsibilities,
accountability, and reporting mechanisms across the VA organizations
engaged in addressing the unique needs of women Veterans.

The WVTF recommends that the initial cross-VA action plan for women Veterans
address the four priority themes identified by the working group in fall 2011:

Capacity and Coordination of Services. This theme addresses the development

of systems to ensure appropriate health care staffing projections for primary
care, mental health care, and relevant specialty care to meet the current and
projected needs of women Veterans; and the enhancement of efforts to
coordinate provision of care and services across VA and between VA and
other federal, state, and community-based organizations. The action plan
should address specific subpopulations of women Veterans, including racial
and ethnic minority groups, rural Veterans, OIF/OEF/OND, and homeless
women Veterans.
Environment of Care and Experience. This theme focuses on ensuring 100
percent resolution of identified gaps in the Environment of Care (EOC) for
women at VA facilities, including addressing guidelines to safeguard the
dignity, respect, and security of women Veterans in inpatient, outpatient, and
residential VHA environments. The EOC is made up of three basic elements:
(1) the building space, including how it is arranged and the special features
that protect patients, visitors, and staff; (2) equipment used to support
patient care or to safely operate the building space; and (3) people, including
those who work within the hospital, patients, and anyone else who enters the
environment, all of whom have a role in minimizing risks.18 This theme also
addresses the need for culture change across VA to reverse the enduring
perception that a woman who comes to VA for services is not a Veteran
herself, but a male Veteran’s wife, mother, or daughter. Women Veterans
often report feeling that their service in the military is not recognized or
respected. 19
Employment and Training. This theme addresses improving employment
rates among women Veterans who have faced unique challenges in
transitioning to civilian employment. The plan of action in this area should
complement current efforts to address Veteran unemployment. Whenever
possible, efforts to improve the transition process for women should be
informed by research that evaluates whether women Veterans are

18
http://www/utmb.edu/envcare/
19
Foster LK, Vince S. California’s Women Veterans: The challenges and needs of those who served. California
Research Bureau. CRB 09-009. August 2009.
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 13

maximizing services such as vocational rehabilitation, compensated work

therapy for Veterans with disabilities, and intervention assistance (e.g.,
tutoring) for those eligible for a VA education benefit; and that measures
long-term impact of education and training received through the VA or
Department of Labor programs.
Data Collection and Evaluation of Services. The task force believes that
continuous improvements in services and benefits must be data-driven and
evidence-based, and must rely on robust feedback from customers and
stakeholders. These continuous improvements must capitalize on existing
expertise and available data and evaluation initiatives. Challenges will
include developing the methodologies and systems for collecting and
evaluating appropriate data, sharing data across organizational boundaries,
and providing the needed analysis to drive informed strategies and policy
decisions.

The following sections of this strategy report introduce each of the four themes to
be addressed in a cross-VA action plan on women Veterans. Each section includes
preliminary goals and objectives as the framework for the action plan. The report
concludes with a section on the organizational accountability, collaboration, and
transparency that will be needed to ensure successful implementation of the new
strategic direction regarding women Veterans.
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 14

Capacity and Coordination of Services

Problem Statement
Due to the projected increase in demand, VA will need to increase its capacity to
provide consistent and coordinated access to comprehensive services and benefits
that meet the unique needs of women Veterans, driving action to achieve the
optimal resource mix at the appropriate locations to meet this dynamic demand.

Women Veterans represent 8 percent of the total Veteran population and are
projected to reach 10.7 percent by 2020.
Enrolled women Veterans represent 6.7 percent of the total enrolled
Veterans population.
Approximately 55 percent OEF/OIF/OND women Veterans currently use VA.

Goal 1 Objectives

Provide timely services 1.1: Assess existing VA workforce to determine ability to meet
and benefits that meet the expected increased demand.
the needs of the growing
population of women 1.2: Ensure every site of care has a trained and proficient
Veterans (utilizing workforce to meet the needs of women Veterans.
WVHSHG mission
strategic plan as a 1.3: VHA, VBA, and NCA will ensure they have sufficient ability
model). to accommodate women Veterans who request access to staff of
specific gender.

Goal 1 and objectives address the need to appropriately match VA workforce

capacity to the increased demand for services by women Veterans, to ensure
proficiency of the workforce, and to accommodate requests for staff of specific
gender.

Goal 2 Objectives

VA (VHA, VBA, NCA) 2.1: VA will use eBenefits as a platform to provide a central
will collaborate in the pathway for comprehensive VA benefits and services
coordination of information that permits women Veterans to craft a Customized
services and benefits Individual Plan (CIP).
that achieve optimal
outcomes for women
Veterans. 2.2: VA will develop an integrated process for every woman
Veteran who requests services and/or benefits to ensure that
she is provided the opportunity to create a CIP that addresses
her specific needs.
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 15

Goal 2 and objectives take on the needs of women Veterans by providing

individualized care and alternate means of interacting with VA.

Goal 3 Objective

Enhance the 3.1: Develop and deploy a One-VA comprehensive (uniform)

coordination and women Veterans services and benefits package for outreach
integration of outreach
targeting all women
3.2: Strengthen partnerships with Veterans Service
Veterans.
Organizations (VSOs) and other stakeholders (federal, state,
county, and local) to enhance outreach and education to women
Veterans.

Goal 3 and objectives seek to create a clearly defined, accessible, united core of VA
benefits and services for women Veterans and to communicate this through a
collaborative outreach program.

Outcomes

1. Women Veterans and their families find it easier to access the right benefits
and health care while meeting their expectations for quality, timeliness and
responsiveness
2. Increased enrollment by women Veterans
3. Increased use of benefits and services by women Veterans.
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 16

Environment of Care and Experience

Problem Statement
Gaps exist in personal privacy, dignity, security, and respect that impact the overall
women Veterans' experience in VA.

Given the current population needs and forecasted increase in the number of
women Veterans eligible for VA services, care, and benefits, it is critical that these
gaps are addressed immediately.

Goal 1 Objectives

VA will create a women 1.1: Eliminate or address remaining VHA-identified facility

Veteran-centric deficiencies by 2013.
environment that
exceeds VA standards 1.2: Assess VBA and NCA structures for personal privacy,
for personal privacy, dignity, security, and respect compliance.
dignity, security, and
respect, in a manner 1.3: Design physical environments that take into consideration
consistent with the changing women Veteran demographics and new concepts
applicable law. This in Veteran-centeredness.
goal will be
accomplished in 1.4: Design alternate modalities (e.g., virtual, tele-medicine,
collaboration with the kiosks, etc.) that take into consideration the changing women
VA construction office. Veteran demographics and new concepts in Veteran-
centeredness.

Goal 1 recognizes the need to eliminate or address through interim measures the
remaining environment-of-care deficiencies at VHA facilities and to identify and
remedy any environmental deficiencies at VBA and NCA facilities. In addition, it
considers means for ensuring that future facilities and alternate modalities of care
delivery are appropriately designed.

Goal 2 Objectives

VA will create a women 2.1: Invest in innovative and creative means to reach all
Veteran-centric employees (messaging, video), and ensure inclusiveness of
environment that women Veterans in all relevant training programs, developing
exceeds their new training materials as required. Cultural transformation
expectations for efforts with regard to women Veterans should go hand-in-hand
services and benefits. with the global efforts around VA’s Veteran-Centric
transformation.

2.2: Increase the total number of women Veterans who are

aware of VA benefits and services and the steps they must take
to access them.
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 17

2.3: Exceed process and client satisfaction measures for

eligibility determination, application, approval, and enrollment
for all benefits and services that VA offers and measures.

Goal 2 reflects importance of increasing women Veterans' awareness of VA benefits

and services, and of equipping all VA staff to interact respectfully and effectively
with women Veterans.
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 18

Employment and Training

Problem Statement
Women Veterans continue to face unique challenges in the area of employment. In
2011, the annual average unemployment rate for women Veterans was 9.1 percent
compared with 8.2 percent for non-Veteran women. Among 18-24 year-olds, the
unemployment rate for women Veterans was 36.1 percent compared to 14.5
percent for their non-Veteran counterparts. 20

There is a lower percentage of women Veterans with a Bachelor’s degree than non-
Veteran women:

Among women aged 17-24, 4 percent versus 10 percent

Among women aged 25-34, 24 percent versus 35 percent (2009)21

There is insufficient integration and collaboration within VA and among external

resources in the area of employment and career development/workforce training
for women Veterans.

Goal 1 Objectives

Increase employment 1.1: Identify existing employment-related programs and

and retention of perform gap analysis.
women Veterans by
leveraging public and 1.2: Identify issues specific to women Veterans that impact
private sector their employment such as Military Sexual Trauma (MST),
resources and mental health ,homelessness, childcare, dependent care, etc.
improving synergy,
integration, and 1.3: Develop and implement a comprehensive women Veterans'
collaboration. employment plan.

Goal 1 seeks to assess available Federal, state, and non-profit programs related to
employment and job retention and to better leverage these programs to improve
employment levels of women Veterans.

20
Employment Situation of Veterans 2011; Briefing by Bureau of Labor Statistics, March 19, 2012.
21
America’s Women Veterans; Military Service History and VA Benefit Utilization Services, VA National Center for
Veterans Analysis and Statistics, November 23, 2011.
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 19

Goal 2 Objectives

2: Enhance 2.1: Increase capacity of women Veterans to market their skills

marketability and and advance their careers.
professional
development of women 2.2: Enhance internal VA capacity to effectively deliver career
Veterans through development/ workforce training resource information, and
career development/ reintegrate women Veterans in the workplace.
workforce training.

Goal 2 addresses the need for on-going career planning and development women
Veterans, which includes navigation to appropriate Federal, state, and local
education and training resources.
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 20

Data Collection and Evaluation of Services

Problem Statement
One challenge VA faces in meeting the ongoing and emerging needs of women
Veterans is the lack of sufficient and actionable data used to deliver quality benefits
and services.

Goal 1 Objectives

1: Collect high-quality, 1.1: Conduct an initial assessment of stakeholder data needs by

gender-specific data to the end of FY12.
meet stakeholder
needs. 1.2: Develop a coordinated approach for enterprise-wide data
collection, management, and analysis processes by end of FY12.

Goal 1 addresses the need for an effective approach to enterprise-wide collection,

sharing, management, and analysis of gender-specific data. Key actions will include
identifying the data required to answer relevant policy and planning questions, and
to measure achievements in meeting women Veterans' needs.

Goal 2 Objectives
2: Use data to evaluate 2.1: Evaluate the needs and measures of success of women
services to address Veteran programs, services, and benefits and the effectiveness of
women Veterans' the VA-wide outreach effort specifically to women Veterans by
needs. the end of FY12.
2.2: Evaluate the needs and satisfaction of Women Veteran
programs, services, and benefits in terms of capacity, access,
quality, cost, and utilization by the end of FY13.

Goal 2 addresses how data will be used, measured, and continuously improved, the
effectiveness of outreach to women Veterans, and their satisfaction with VA
programs, services, and benefits.
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 21

Organizational Accountability, Collaboration, and

Transparency
There has been a considerable investment in enhancing VA’s programs, benefits,
and services for women Veterans but there remain policies, practices, programs,
and related activities that are not yet fully responsive or sensitive to the needs of
women Veterans. There is leadership support, significant efforts, and passionate
internal and external stakeholders; however, these activities remain fragmented.

Throughout VA a variety of organizations perform women Veteran related policy

development, official information dissemination, internal and external
communications, outreach to the public, internal and external training and provide
direct delivery of service to women Veterans. These activities are not always
effectively communicated or coordinated across the Department.

We must enhance the effective delivery, accountability, resource management and

sustainability of services and benefits for women Veterans.

Key Efforts
Develop a department-wide integrated action plan for meeting the needs of
women Veterans. (This document is the outline of that plan.)
Analyze the current organizational design, relationships and internal
accountability measures and mechanisms. Identify organizational and
business process enablers and barriers throughout VA, and identify
opportunities for improvement.
Formalize the roles, responsibilities, accountability and reporting
mechanisms across the VA organizations that are engaged in addressing the
unique needs of women Veterans.
Draft for Public Comment • 2012 Women Veterans Task Force Report Page 22

Conclusion
At VA, we are committed to providing high-quality services and benefits to America’s
Veterans. Meeting this commitment requires ongoing adaptation and transformation. As
Secretary Shinseki explained, “This transformation is demanded by new times, new
technologies, new demographic realities, and new commitments to today’s Veterans. It
requires a comprehensive review of the fundamentals in every line of operation the
Department performs.” In this spirit, Secretary Shinseki has charged the Women
Veterans Task Force with developing a comprehensive VA action plan in how our
organization serves women Veterans, a timely effort given the rapid growth in the women
Veteran population. This draft strategy report represents the first phase in the
development of such a comprehensive action plan. Public comments are being sought at
this early stage to ensure that the expertise and experience of our diverse stakeholders and
partners can inform the ultimate plan. We believe that the strong support demonstrated by
VA leadership, together with the commitment of our stakeholders, will equip VA with
the ingredients for success in addressing the unique care and service needs of our women
Veterans.
 Draft for Public Comment • 2012 Women Veterans Task Force Report
Appendix A
Members of the Women Veterans Task Force, Categorized by Working Group
Capacity and Coordination of Services
Karen Malebranche, Executive Director, Interagency Health
Affairs (VHA); Co-Chair
Michela Zbogar Chief Medical Officer (VHA, VISN 8); Co-
Chair
Julie Carie, VSO Liaison (VBA, BAS)
Serena Chu, Program Analyst (VHA, Rural Health)
Stacy Garrett-Ray, Deputy Director, Comprehensive
Women’s Health (VHA, WVHSHG)
Amy Marcotte, Team Lead (VHA, Vet Centers)
Jeanette Mendy, Health Systems Specialist (VHA, IHA)
Stephanie Robinson, Program Analyst (OPIA, HVIO)
Richard Stark, Director, Primary Care Clinic Operations
(VHA, Primary Care)
Sally Haskell, Acting Director, Comprehensive Women’s
Health (VHA, WVHSHG)
Environment of Care and Experience
Aubrey Weekes, Director, Environmental Program Service
(VHA); Co-Chair
Abdoulie Jammeh, Bay Pines VAMC Assistant Chief,
Environment Management Service (VHA); Co-Chair
Sonja Batten, Deputy Chief Consultant for Specialty Mental
Health (VHA)
Vonda Broom, Deputy Director, Environmental Programs
Service (VHA)
Anna Crenshaw, Chief, Client Services Outreach (VBA, BAS)
Elizabeth Helm-Frazier, Program Assistant, Office of
Strategic Planning (VBA)
Kate Hoit, New Media Specialist (OPIA)
Connie LaRosa, Deputy Field Director, WVHSHG (VHA)
Billie Randolph, Deputy Chief Prosthetics Officer (VHA)
Employment and Training
Georgia Coffey, Deputy Assistant Secretary for Diversity
and Inclusion (VA); Co-Chair
Joan Ricard, Director, El Paso VA Health Care System
(VHA); Co-Chair
Cathy Abshire, Program Manager, VHA Homeless Programs
(VHA)
Chanel Bankston-Carter, Program Management Officer
(VESO)
Stephanie Birdwell, Director, Office of Tribal Government
Relations (OPIA)
Sharon Crowder, LCSW, CPRP, Office of Mental Health
Operations and Office of Operations and Management
(VHA)
Bridget Griffin, Program Analyst (VBA, BAS)
Betty Moseley-Brown, Associate Director (CWV)
Annette Taylor, Education Specialist (VALU)
Angela Wilcher, Program Analyst (VBA, VRE)
Page 23
Data Collection and Evaluation of Services
Shana Brown, Assistant Director, San Diego RO (VBA); Co-
Chair
Christi Greenwell, Assistant Director (VBA, BAS); Co-Chair
Murielle Beene, Acting Deputy Director for Health
Infomatics (VHA)
Tom Garin, Program Analyst for OPP (VA)
Kate Hoit, New Media Specialist (VHA)
Candace Ifabiyi, Program Analyst for OPP (VHA)
Michelle Lucatorto, Program Manager (VHA)
Cathy Rick, Chief Nursing Officer (VHA)
Kenneth Wagner, Director for OPP (VA)
Faith Walden, Program Analyst (NCA)
Elizabeth Yano, Co-Director, Center for Excellence (VHA)
Laurie Zephyrin, Director, Reproductive Health (VHA)
Planning for the Future
Lillie Jackson, Assistant Director, Buffalo RO; Co-Chair
Susan Sullivan, Director of Strategic Planning, (VACO); Co-
Chair
Deborah Amdur, Chief Consultant, Case Management &
Social Work (VHA)
Lauren Bailey, Acting Deputy Director, Online
Communications (OPIA)
Ruth Fanning, Director, Vocational Rehabilitation and
Employment (VBA)
Robin Ficke, Legislative Staff, Compensation Service
Sarah Goddard
Patricia Hayes, Chief Consultant (VHA, WVHSHG)
Catherine Trombley, Communications Specialist (VBA)
Carrie Tuning, Learning Consultant (VALU)
Stacey Vasquez, Deputy Director, (OPIA, HVIO)
Stephanie Willis, Strategic Management Group (HRA)
 Draft for Public Comment • 2012 Women Veterans Task Force Report Page 24

Appendix B
History of VA Efforts to Improve Services and Benefits for Women Veterans

Women have served in U.S. military efforts since the American Revolution, and were
first granted a formal role in the armed forces with the creation of the Army Nurse
Corps in 1901.22 The U.S. Code does not make a distinction between male and
female Veterans. However, the reality is that women have not always had equal
access to all Veterans' benefits. Beginning in the 1980s and 1990s, as more
information became available about gender disparities in VA care and benefits for
women Veterans, VA took a number of action, some mandated by Congress, to
ensure better access to services and benefits for women Veterans. Milestones in the
evolution of VA services to women Veterans are highlighted below.

VA for Women Veterans Timeline – VA has come a long way

1972: Public Law 92-540 clarifies that the term “wife” includes the husband of any female Veteran, and the term
“widow” includes the widower of any female Veteran.
1980: Women comprise less than 2 percent of the Veteran population; 1980 Census finds 1.2 million women
served in the Armed Forces.
1982: GAO report reveals lack of access to psychiatric care because facilities cannot accommodate women. Also,
women Veterans received little to no gynecological care.
1983: Secretary’s Advisory Committee on Women Veterans is established with reporting requirements to the
VA Administrator and to Congress on needs of women Veterans and recommendations for action.
1984: First report of the Advisory Committee identifies the need for strong outreach and the lack of adequate
privacy and gender-specific treatment for women at VA facilities as the most pressing areas of concern.
1985: First VA-commissioned survey of women Veterans reveals that 57 percent of women did not know they
were eligible for VA services or benefits. Also, women Veterans reported twice the rates of cancer compared to
women in the general population, with gynecologic cancers being most common.
1986: Advisory Committee recommendations to improve outreach spur creation of women Veterans
coordinator positions at VBA regional offices and at VA medical centers.
1988: First office to address women’s health issues is created within the Veterans Health Administration.
1992: Sixty percent of VA medical facilities have women clinics offering gynecologic care as well as preventive
health and counseling services. All domiciliaries are able to admit women. P.L.102-585 authorizes counseling
for sexual trauma that occurred while on active duty. Four comprehensive women Veteran Health Centers
established, expanded to eight in 1993.
1994: National training program for women Veteran coordinators. Some full-time coordinator positions added
at VA medical centers and VBA regional centers. Congress establishes the Center for Women Veterans through
P.L.103-446. The Center director reports directly to the VA Secretary and ensures VA programs are responsive
to the needs of women Veterans.
Compensation and Pension Service Advisory Committee on Women’s Issues is created within VBA to review
policy and procedures regarding benefits delivery for women Veterans.
22
Willenz JA (1983). Women Veterans: American’s Forgotten Heroines. New York: The Continuum Publishing
Company, p.15
 Draft for Public Comment • 2012 Women Veterans Task Force Report Page 25

VA for Women Veterans Timeline – VA has come a long way (continued)

GAO reports VA has had great success in improving privacy protections for women Veterans in VA facilities. VA
completed more than 130 projects to improve facilities and spent more than $672 million.
In 1996, P. L.104-262, authorized the provision of both inpatient and outpatient care to eligible Veterans. In
implementing this authority, VA defined a medical benefits package that is available to Veterans enrolled in
VA’s health care system. The package includes comprehensive prenatal, intra-partum and post-partum care to
eligible women Veterans.
By 1997, partly through improved outreach, outpatient and inpatient visits among women Veterans increased more
than 50 percent from 1994 to1997 and the number of women receiving gender-specific services (Pap smears,
mammograms, reproductive health care) increased more than 40 percent from more than 85,000 to over
121,000 women.
In 2000, VA supports demonstration programs at 11 locations across the country specifically for homeless
women Veterans.
2000: Congress authorizes special monthly compensation for women Veterans with a service-connected
mastectomy and provides benefits for children with birth defects born to Vietnam Veteran women.
2008: Advisory Committee recommends that the position of women Veterans program manager (WVPM) be
established as a permanent full-time management position in all VA medical centers. Secretary request that
VAMCs establish WVPM as a full-time position by no later than December 1, 2008. There are currently over 140
WVPMs. There are 57 designated women Veteran coordinators to help with benefits services in the VBA
Regional Offices.
The 2010 ACWV report recommends a full-time WVC in Regional Offices with a female Veteran population
(catchment area) greater than 40,000.
GAO reports in 2009 and 2010 find that basic gender-specific services, including pelvic exams, were available
at nearly all facilities visited and that the majority of facilities also offered access to one or more female
providers.
2008: VHA reports that VA performs better than private sector on gender-specific measures of breast and
cervical cancer screening.
2009: National Survey of Women Veterans indicates outreach efforts have enhanced understanding, but still
indicate potential for improvement. About 30 percent of women surveyed did not think they were eligible for
VA benefits, almost half the percentage who thought they were ineligible in 1985.
2010: Advisory Committee recommends in its 2010 report that VA provide childcare options for eligible
women Veterans, utilizing public and private partnerships, in order to facilitate access to quality health care
services. Free drop-in childcare pilots open to Veterans eligible for VA care while at VA appointments are being
implemented at three VA medical centers: Buffalo, NY; Northport, NY; and Puget Sound, WA.
2011: Veterans Health Administration establishes a National Call Center for Women Veterans.